America and the Pill: A History of Promise, Peril, and Liberation (13 page)

Even the lowly jockstrap seemed to offer contraceptive po- tential. In 1975,
Esquire
, hostile to the idea of vasectomies, waxed

enthusiastic about this benign undergarment: “The jockstrap, its place in sports history already snugly secure . . . will be credited with contributing mightily to the protection of mankind from grievous pain, injury, insult
and
, it now appears tantalizingly possible,
overpopulation.
” The article quoted John Rock, who noted that sperm output declines when the testicles are heated. “Daily wear of a well-fitting, closely knit jockstrap results in in- fertility after four weeks.” Although the jockstrap was hardly foolproof,
Esquire
found it to be much preferable to other meth- ods that might emasculate the man. According to Dr. Sheldon Segal of the Population Council, “A man
could
take his wife’s oral contraceptives and he’d be incapable of fertilizing her within fourteen days, but his libido would be shot to hell, too,” and another researcher warned, “Start interfering with sperm production and before you know it you’ve got a pussycat.”
29

Theoretically, however, the jockstrap idea had potential. Ac- cording to Dr. Mostafa S. Fahim, a reproductive pharmacologist, “If we’re ever going to have any impact on world overpopulation, we’ve got to have a contraceptive that is neither surgical nor pharmacological, something even the poorest and most illiterate can make use of.” Using the concept of heat to develop new male methods, he constructed a device to warm the testicles to the level that would inhibit sperm production. It was a “water- activated battery” that could heat up to 230 degrees Fahrenheit. “Inserted in a spongelike material, it can easily be shaped into a pouch suitable for heating the testes.” The pouch was to be worn half an hour at a time and then discarded. Fahim pointed out that the device was preferable to a vasectomy because it was nonsurgical and reversible. “Things look very good now, but we

must still perform complex, long-term genetic and biochemical tests on a large number of subjects. We mustn’t be hasty. We don’t want this to be like The Pill and now, perhaps, vasectomy, where troubles begin to manifest themselves years after millions of people have already become involved.”
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This device, like the others, never made it to market.

While these various alternatives were being studied, re- searchers continued their efforts to develop a contraceptive pill, injection, or vaccine for men. In the late 1960s, one drug under consideration was Agent U5897, a “common industrial compound used in the manufacture of dynamite” that prom- ised to be free of the serious drawbacks that had hampered the development of the male pill, especially the problem of re- duced libido. U5897 was not ready for human trials, however, because of toxic side effects. The silver lining in the research was the discovery that the drug was effective in stemming the fertility of laboratory rats, suggesting that even if the drug was not practical for humans, it could be used to reduce the popu- lation of rodents. The
Minneapolis Tribune
reported this find- ing under the unfortunate headline, “Antifertility Drug Developed for Men, Rats.”
31

With all the hormonal methods being tested, scientists ac- tually discovered an effective vaccine that completely stopped the production of sperm without interfering with sex drive. But it had an unacceptable side effect. According to the re- searchers studying the vaccine, “There is one drawback which indirectly affects libido, and because of this drawback, I quite honestly doubt we’ll ever be able to use the vaccine. The testes get smaller—about a third smaller—so this approach will never

work. The psychological trauma of shrinking testes just cannot be overcome.”
32
Antifertility injections were also under scrutiny as early as the 1960s, but they had the same problem.
Good Housekeeping
reported that investigators were searching for methods that would not reduce the size of the testicles. Other promising possibilities included a capsule containing a syn- thetic male hormone that would be implanted under the skin to prevent sperm formation. Removing the capsule would re- store fertility (much like Norplant for women).
33

In 1981, researchers at Vanderbilt University reported tests of a daily injection for men of the drug luteinizing hormone– releasing hormone, or LHRH, that suppressed sperm produc- tion and lowered testosterone. When it was tested on eight men between the ages of twenty-eight and forty-two, the in- jections were found to be nontoxic, and all subjects regained their fertility after discontinuing use. But yet again, some of the volunteers experienced a loss of sex drive, impotence, and “momentary increases in body temperature, or so-called hot flashes, such as those experienced by women after menopause.” The scientists began working on a compound that would elim- inate the side effects and said that it could take several years before the drug would be considered safe for marketing.
34

Six years later, the
New York Times
reported that researchers were testing another birth control injection for men, which used a synthetic form of testosterone to inhibit the production of sperm. Under the auspices of the World Health Organiza- tion, the medication was being tested in several countries, in- cluding the United States, where thirty Seattle men were involved in the trials. Though the results didn’t show any neg-

ative effects on sex drive or other “personality factors,” the in- jections were not 100 percent effective. Researchers were try- ing to refine the dosage to lower the failure rate to less than 1 percent. The major hurdle was that the contraceptive required a weekly injection. Of course, those scientists did not seem to consider it impractical for women to consume a pill every day. But they believed that men would be unwilling to take an in- jection every week.
35

Scientists who devoted years of work trying
to develop an effective and acceptable male contraceptive bris- tled at the accusation that chauvinism prevented the introduc- tion of a contraceptive for men. Writing in 1972, Dr. Sheldon Segal explained that it is much more difficult to intervene in the physiological and chemical constitution of the male repro- ductive system.
36
A quarter of a century later, researchers made a similar point: “All you have to do with women is to knock out the production of one egg per month, but men produce something like 250 million sperm cells per ejaculation. Sup- pressing this gigantic factory of sperm production in men is a lot more difficult.”
37

Other scientists dissented from this view, arguing that it was not necessarily more complicated to prevent sperm pro- duction than to inhibit ovulation. Nevertheless, most agreed that for a variety of reasons, ranging from human biology to funding and testing constraints, the development of a male pill would be difficult. In 1983, in her column in the
New York Times
, Jane Brody supported the claim that physiology was the greatest barrier to male contraception. Noting that many

feminists believed that “male researchers feel more comfortable tampering with a woman’s physiology than with their own,” she nonetheless agreed with the view that “basic biology re- mains the greatest barrier to developing male contraceptives.” Taking on the single most controversial point in any discussion of a male pill, she continued, “The organ that produces sperm also makes the male sex hormone testosterone, which is respon- sible for libido, potency and secondary sex characteristics. . . . By contrast, ovarian function need not be wholly suppressed to prevent ovulation. And since a woman’s libido is not a function of ovarian hormones, but of other sex hormones produced in the adrenal glands, side effects are more easily avoided.”
38

A month later, the
New York Times
editorialized that while men and women should share the responsibility for birth con- trol, it would probably be twenty years before a new male contraceptive would be available. The editorial promoted va- sectomies and cited a study showing the procedure to be safe and effective. Yet it concluded that the ideal birth control was still a long way off: “Someday somebody somewhere will de- velop the perfect contraceptive, suitable for both sexes with no health risk whatever.”
39

There were, of course, cultural reasons for the relative lack of attention to male contraception. The emphasis on women is em- bedded in the institutional frameworks of science, medicine, and pharmaceuticals. Both women and men think of reproduction in terms of women’s bodies and of birth control as a woman’s re- sponsibility. The fact that the medical profession generally con- siders reproduction a female concern has led to a scarcity of doctors trained in male reproductive medicine and a shortage of

scientists interested in working on male contraception. Ronald Ericsson, one of the researchers in the field of male contracep- tion, complained in 1973 that male contraceptive research “is al- most an illegitimate specialty within reproductive biology.” As late as the 1990s, male contraceptive researchers complained that they were considered “second-class scientists.”
40

Some researchers speculated that the heightened scrutiny of new pharmaceuticals made it more difficult and time-consuming to gain approval for human trials and bring new methods to market. As early as 1977, Dr. Don Fawcett of the Harvard Medical School warned that it would be many years before “
she
will ask
him
, ‘Did you take your pill today, dear?’ ” He noted that since the FDA approved the pill in 1960, much stricter regulations governing experimentation on human subjects had been put into place, hampering the search for a male pill. “When [the FDA] didn’t approve thalidomide [the drug that caused thousands of severe birth defects in Europe] for mar- keting, that put them on the map, and so now the tendency is to be extra cautious. If the FDA official has even the slightest doubt, the easiest thing for him (sic) to do is to say, ‘go back and do 1000 more rats.’ ” (The FDA official who blocked ap- proval of thalidomide was, in fact, a
she
—Frances Oldham Kelsey.)
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Regulations aside, there was still the problem of the men themselves. “There is nothing inherently difficult about finding chemicals to inhibit male reproductive capacities,” Fawcett explained, but the question remained, “Will they use it? Will men, even in a pill-popping society like ours, take to taking the pill?” He predicted that older men might resist but that young men would be open to the idea.
42

Indeed, he may have been right. A generation after Faw- cett’s prediction, men’s reluctance may be declining. In the wake of the feminist challenge to traditional gender norms, a new concept of manhood that includes qualities of caring and taking responsibility has eroded earlier attitudes that equated masculinity with sexual conquest. Although none claimed that male contraceptives would contribute to men’s freedom or re- productive rights, men who participated in clinical trials of new contraceptives saw themselves as caring partners. In 2008, twenty-three-year-old Erin M wrote in response to an online survey that it was “unfortunate that male hormonal contracep- tives are not on the market, because my husband would volun- teer for it (we’ve talked about it).” She worried, however, about its safety: “I would be uncomfortable with that until male birth control had been well tested, though.”
43

To persuade volunteers to participate in studies, researchers appealed to their sense of masculine bravery and heroism. Mak- ing this point explicit was a poster used to recruit volunteers in Edinburgh, Scotland. Next to an image of an astronaut perched on the surface of the moon were bold letters proclaiming, “FIRST MAN ON THE PILL.” By the early twenty-first century, as researchers continued to work on developing a male contraceptive pill, most believed that men would be receptive, especially those in stable relationships. Noted one doctor: “It won’t work for the 17-year-old at the nightclub looking for a contraceptive but will for men in relationships.” Another noted that the question of trust would be all important: “A woman would be mad to believe a chap she met in a night club who said: you’re all right love, I’m on the Pill.”
44

By 2008, that scenario seemed not so absurd. Kansas City journalist Jonathan Bender wrote that with new male contracep- tives due within a year, “The hotel bar pick up will have a de- lightfully different spin. So next year when a guy says, ‘Don’t worry, I’m on the pill,’ you can relax.” Bender welcomed the in- troduction of a male pill, injection, or patch. Noting that the major side effects appeared to be weight gain and increased mus- cle mass, he quipped, “But hey who doesn’t like bigger pecs?”
45
(The comment echoed the happy responses of some female pill users who discovered that the pill enlarged their breasts.)

No longer a spoof of absurdly reversed gender
roles, in the twenty-first century many of the leading physi- cians and scientists involved in developing male contraceptives are women. Dr. Andrea Coviello, one of the researchers in- volved in testing a microcapsule injected under the skin that releases testosterone over three months, noted that the tech- nology has been developed but cautioned that the availability of the new method depended on continued funding. Using methods similar to the oral contraceptive for women, the male compound would use hormones such as testosterone and pro- gestins to turn off sperm production. According to Dr. Christina Wang, who is directing the study at Harbor-UCLA Medical Center in Los Angeles, the first male hormonal contracep- tive would probably be an injectable or an implant similar to Norplant for women. Studies under way suggest that the im- plants are “safe, effective, inexpensive, and entirely reversible.” She predicted FDA approval within five years. The California researchers are collaborating with scientists in China, where

1,000 men are involved in clinical trials to develop low-cost, effective, and reversible male contraceptives with minimal side effects. Dr. Wang notes that there is greater interest in male contraception, and more funding available worldwide, than ever before.
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